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PERAC General Membership Forms

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Table of Contents

Member Benefit Forms

Application for Reinstatement to Service (PDF 48.38 KB)
Authorization to Use or Disclose Protected Health Information (PDF 53.76 KB)
Beneficiary Change Form (PDF 302.88 KB)
Beneficiary Selection Form (PDF 333.73 KB)
Beneficiary Selection Form (Option D form) (PDF 312.12 KB)
Disability Application Glossary of Terms (PDF 126.97 KB)
Disability Retiree Earned Income Worksheet (PDF 172.83 KB)
Disability Retirement Application (PDF 433.55 KB)
Disability Retirement Benefits for Veterans (PDF 104.73 KB)
Instructions for Submitting the Annual Statement of Earned Income (PDF 64.4 KB)
New Member Enrollment Form (PDF 349.66 KB)
Pre-Tax Rollover Form (PDF 71.28 KB)
Refund Form (Member) (PDF 263.55 KB)
Retirement Application (voluntary superannuation) (PDF 318.71 KB)
Retirement Option Selection Form (PDF 340.58 KB)
Special Tax Notice Regarding Lump Sum Distributions (PDF 164.78 KB)
Statement Concerning Your Employment in a Job Not Covered by Social Security (PDF 173.25 KB)
Veterans' Buyback Form (PDF 495.47 KB)
Waiver of Applicant Attendance at Medical Panel Examination During COVID-19 Pandemic (PDF 329.47 KB)

Survivor Benefit Forms

Application for Member Survivor Benefits (PDF 366.21 KB)
Notice of Election of Benefits under 12(2)(d) (PDF 252.15 KB)
Refund Form (Beneficiary) (PDF 198.56 KB)
Spousal Affidavit to Determine Benefit Eligibility (PDF 323.34 KB)
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